Transcript Document

Evaluation of the National HIV Behavioral Surveillance System
Among Men Who Have Sex With Men in Denver, Colorado
Kathryn DeYoung, MS1, Arthur Davidson, MD, MS1, Alia Al-Tayyib PhD1
1Denver
Public Health, Denver, USA
Background
Men who have sex with men (MSM) account for the
majority of new HIV diagnoses in Denver.
The National HIV Behavioral Surveillance System (NHBS) is a
20-site cyclical survey of those at increased HIV risk. Men
who have sex with men (MSM) are surveyed every three
years.
Conclusions
Demographic characteristics and HIV testing history among Denver MSM by data source
Representativeness: Good
 Site works to represent African Americans and Hispanics
 Inclusion of younger MSM increasing but hindered by
venue options
 Concern: representation of internet-based MSM population
Total
Race / Ethnicity
American Indian
Black
Hispanic
Other / Mixed race
White
Age
18 – 24
25 – 29
30 – 39
MSM cycles utilize a time-space venue-based sampling
approach, recruiting at bars, restaurants, and other venues
with a high ratio of MSM attendees.
NHBS has not been previously evaluated in Denver.
Objective
To evaluate implementation of the MSM1, MSM2, and
MSM3 cycles of NHBS in Denver, conducted in 2005, 2008,
and 2011, respectively.
Methods
CDC guidelines for evaluating public health surveillance
systems include these attributes:
 Acceptability, flexibility, simplicity (qualitative)
 Data quality, representativeness, system sensitivity
(quantitative)
Results
NHBS
n(%)
1919
Outreach2
n(%)
1794
STD Clinic
n(%)
3560
24 (1)
126 (7)
454 (24)
124 (7)
1172 (62)
16 (0)
247 (7)
845 (24)
180 (5)
2272 (64)
19 (1)
105 (6)
346 (19)
136 (8)
1188 (66)
261 (14)
292 (15)
579 (30)
861 (24)
742 (21)
958 (27)
318 (18)
295 (16)
430 (24)
40– 49
>50
Mean Years Since Latest HIV Test4
(95%CI)
Last Known HIV Status3
487 (25)
300 (16)
2.27
(2.08-2.45)
634 (18)
365 (10)
1.77
(1.57-1.98)
397 (22)
354 (20)
1.52
(1.30-1.75)
Negative
Positive
1505 (83)
281 (16)
960 (88)
102 (9)
911 (94)
47 (5)
Indeterminate/Unknown
New HIV Diagnosis4,5
25 (1)
34 (3)
32 (3)
37 (4)
8 (1)
23 (2)
1 US
Census, Denver-Broomfield MSA, 2010
2Outreach:2008 and 2011 data only
3American Community Survey, Denver County, 2007-2011
Limitations
There is no comparable population-based sample of MSM
with which to compare NHBS.
Recommendations
Top locations where NHBS respondent met last
male sex partner (by cycle)
Local implementation of NHBS has good representativeness,
sensitivity, acceptability. These could be improved by continuing
efforts to include underrepresented groups and by meeting with
venue owners before events to improve buy-in.
90
% of recent partners met here
80
70
60
50
System complexity reduces local usefulness. Possible solutions
include acquisition of cleaned data and code from CDC; funding
of additional resources for data analysis and communication of
results; and production of a local operations manual to document
changes in NHBS methods over time and other factors to be
considered in interpretation of data.
40
30
20
10
0
MSM1
Bar/club
© 2013 Denver Health
Simplicity: Low
 The cyclical nature of NHBS does not allow adequate time or
funding for local analysis, interpretation, dissemination of
results
 Data management issues
 101 errors corrected in MSM2, 298 corrected in MSM3
 Quality and timeliness of final datasets from CDC improved
after transition to data management by DCC (MSM3)
Clinic and Outreach : 2011 data only
5NHBS: 2008 and 2011 cycles only
Median age by NHBS venue
Denver data sources:
 NHBS MSM cycles: 2005, 2008, 2011
 Denver Public Health records from STD clinic patients and
outreach HIV testing (census, not sample)
 Included patients who would have been eligible to
participate in NHBS-MSM cycles (2005, 2008, 2011)
Acceptability: Good
 Participants: In MSM2 and MSM3, 100% of eligible recruits
interviewed; 84-92% accepted HIV testing
 Venue owners: Participating owners enthusiastic; nonparticipating owners concerned about client impact
 NHBS staff: Satisfied with venue selection, recruitment
methods, and data security
4 STD
Acceptability, flexibility, simplicity, and data quality:
 Assessed through local stakeholder input, reviews of
protocols, local formative research, & process indicators
Representativeness and system sensitivity to trends:
 Comparison of responses to demographic and HIV testing
history questions among Denver NHBS-MSM participants
with comparable samples from local sources
Data quality: Good
 Quality as high as self-report data collection method permits
 Maintained by interviewer-guided data collection
MSM2
MSM3
Internet
Sex establishment
This study was supported in part by an appointment to the Applied
Epidemiology Fellowship Program administered by the Council of State
and Territorial Epidemiologists (CSTE) and funded by the Centers for
Disease Control and Prevention (CDC) Cooperative Agreement Number
5U38HM000414-5.
Contact Information: For more information or for additional copies of this abstract, please contact Kathryn DeYoung at [email protected]